Expectations the White House would make strides toward fighting the opioid epidemic fell short in the eyes of many when President Donald Trump on Thursday formally declared a public health emergency without calling for new funding to support treatment efforts.
Trump announced plans to direct Acting HHS Secretary Eric Hargan to declare the opioid crisis a national emergency under section 319 of the Public Health Service Act. Trump said the scale of the epidemic requires the aid of every federal agency and the resolve of every American.
"I want the American people to know that the federal government is aggressively fighting the opioid epidemic on all fronts,"Trump said.
As a first step, the administration planned to rescind a current Medicaid rule that limits how long patients can receive mental health or substance use disorder treatment in residential facilities with more than 16 beds. Currently the program covers the costs for up to 15 days.
"A number of states have reached out to us asking for relief and you should expect to see approvals that will unlock treatment for people in need and those approvals will come very, very fast," Trump said.
But eliminating the rule would take an act of Congress while the CMS has provided state waivers for some years.
Overall the declaration was seen helping raise public awareness.
"We strongly support President Trump's decision to officially label the opioid epidemic a public health emergency," said Rep. David McKinley (R-WV) in an emailed statement. "As ground zero for this public health emergency, it is time West Virginia received the resources it deserves, and today's action is a big step towards accomplishing that."
"Really, he's going to be asking the entire government to get behind this effort," said Tom Coderre, senior adviser at the Altarum Institute and a former chief of staff and senior adviser to the Assistant Secretary at SAMHSA during the Obama administration. "That's the bigger message of today, but certainly the devil is always in the details."
The president of the American College of Physicians Dr. Jack Ende released a statement saying he was encouraged by Trump's annoucement but pointed out the need for adequate funding. He said the Public Health Emergency Fund currently had only $57,000 as a result of Congress failing to replenish it for several years.
"Efforts need to be made to make substance use disorder treatment more accessible to those in under-served areas," Ende said. " We hope that today's declaration will be used in a way that achieves that goal."
Others were more critical and saw the declaration another disappointment.
Grant Smith, deputy director of national affairs for the Drug Policy Alliance in a written statement called the announcement "a drop in a bucket." "We need a well thought out plan from the Trump administration that resolves the many obstacles people face trying to access medication-assisted treatment and naloxone to save lives."
Baltimore City Health Commissioner Dr. Leana Wen questioned why a broader national emergency, under the Stafford Act, was not declared. That would have made billions in emergency funding available through FEMA's Disaster Relief Fund.
"I looked to the president to commit a specific dollar amount from new funding rather than re-purposed dollars that take away from other key health priorities," Wen said.
Under a public health emergency, HHS will allow states and counties greater flexibility in how federal funds are used. The agency will also seek to waive current rules that prohibit patients from receiving medication-assisted treatment through telemedicine in order expand access.
"That does have a potential to help reach patients who live in more rural areas," said Cynthia Reilly, director of the Pew Charitable Trusts' Substance Abuse Prevention and Treatment Initiative. "It [the declaration] could certainly help with that aspect of the problem."
The order also makes the Department of Labor's Dislocated Worker Grants—usually given to help those out of work due to natural disaster—available to help people who are unemployed because of addiction. At a meeting of Trump's opioid commission held last week, Labor Secretary Alex Acosta testified that this was the "number one issue" in joblessness.
Trump's declaration allows HHS to hire temporary personnel. The agency can also direct states upon its governor's request to temporarily reassign state and local public health department personnel who receive federal funding to work on addressing opioid abuse during the emergency period.
Despite such changes, some addiction treatment experts feel the administration's decision not to call for new funding within the emergency declaration confirms that the White House lacks direction on dealing with the crisis.
"They don't have a plan," said Dr. Andrew Kolodny, co-director of policy research at Brandeis University. "They rattled off a few items, but there's no real plan."